Acute aortic syndromes: definition, prognosis and treatment options

TY - JOUR

T1 - Acute aortic syndromes: definition, prognosis and treatment options

AU - Carpenter, S W

AU - Kodolitsch, Y V

AU - Debus, E S

AU - Wipper, S

AU - Tsilimparis, N

AU - Larena-Avellaneda, A

AU - Diener, H

AU - Kölbel, T

PY - 2014/4

Y1 - 2014/4

N2 - Acute aortic syndromes (AAS) are life-threatening vascular conditions of the thoracic aorta presenting with acute pain as the leading symptom in most cases. The incidence is approximately 3-5/100,000 in western countries with increase during the past decades. Clinical suspicion for AAS requires immediate confirmation with advanced imaging modalities. Initial management of AAS addresses avoidance of progression by immediate medical therapy to reduce aortic shear stress. Proximal symptomatic lesions with involvement of the ascending aorta are surgically treated in the acute setting, whereas acute uncomplicated distal dissection should be treated by medical therapy in the acute period, followed by surveillance and repeated imaging studies. Acute complicated distal dissection requires urgent invasive treatment and thoracic endovascular aortic repair has become the treatment modality of choice because of favorable outcomes compared to open surgical repair. Intramural hematoma, penetrating aortic ulcers, and traumatic aortic injuries of the descending aorta harbor specific challenges compared to aortic dissection and treatment strategies are not as uniformly defined as in aortic dissection. Moreover these lesions have a different prognosis. Once the acute period of aortic syndrome has been survived, a lifelong medical treatment and close surveillance with repeated imaging studies is essential to detect impending complications which might need invasive treatment within the short-, mid- or long-term.

AB - Acute aortic syndromes (AAS) are life-threatening vascular conditions of the thoracic aorta presenting with acute pain as the leading symptom in most cases. The incidence is approximately 3-5/100,000 in western countries with increase during the past decades. Clinical suspicion for AAS requires immediate confirmation with advanced imaging modalities. Initial management of AAS addresses avoidance of progression by immediate medical therapy to reduce aortic shear stress. Proximal symptomatic lesions with involvement of the ascending aorta are surgically treated in the acute setting, whereas acute uncomplicated distal dissection should be treated by medical therapy in the acute period, followed by surveillance and repeated imaging studies. Acute complicated distal dissection requires urgent invasive treatment and thoracic endovascular aortic repair has become the treatment modality of choice because of favorable outcomes compared to open surgical repair. Intramural hematoma, penetrating aortic ulcers, and traumatic aortic injuries of the descending aorta harbor specific challenges compared to aortic dissection and treatment strategies are not as uniformly defined as in aortic dissection. Moreover these lesions have a different prognosis. Once the acute period of aortic syndrome has been survived, a lifelong medical treatment and close surveillance with repeated imaging studies is essential to detect impending complications which might need invasive treatment within the short-, mid- or long-term.

KW - Acute Disease

KW - Aneurysm, Dissecting/diagnosis

KW - Antihypertensive Agents/adverse effects

KW - Aorta, Thoracic/drug effects

KW - Aortic Aneurysm, Thoracic/diagnosis

KW - Aortic Diseases/diagnosis

KW - Aortography/methods

KW - Endovascular Procedures/adverse effects

KW - Hematoma/diagnosis

KW - Humans

KW - Patient Selection

KW - Predictive Value of Tests

KW - Risk Factors

KW - Syndrome

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

KW - Ulcer/diagnosis

KW - Vascular Surgical Procedures/adverse effects

M3 - SCORING: Review article

C2 - 24796906

VL - 55

SP - 133

EP - 144

JO - J CARDIOVASC SURG

JF - J CARDIOVASC SURG

SN - 0021-9509

IS - 2 Suppl 1

ER -